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PubMedDate not supplied

Spinal cord pial metastases: MR imaging with gadopentetate dimeglumine.

The purpose of this investigation was to describe gadopentetate-dimeglumine-enhanced MR findings in metastatic disease to the pial lining of the spinal cord. Correlation was made with clinical data, other radiologic studies, and pathologic findings. Eighty-six patients with a known malignancy and unexplained neurologic signs or symptoms were studied with pre- and postcontrast T1-weighted images. In seven of these patients, abnormal enhancement of the pial lining of the cord was seen on the sagittal postcontrast T1-weighted images. This appeared as a thin rim of enhancement along the surface of the cord in six patients and as a focal, thick rim of enhancement in addition to the thin rim of enhancement in the seventh patient. Axial images confirmed the location along the pial lining in each case. Precontrast T1-weighted images in all seven cases and precontrast T2-weighted images in five cases failed to detect any focal abnormalities of the pial lining of the cord. Pathologic confirmation was available in five of the seven patients. Primary malignancies in these patients included breast carcinoma (two), lymphoma (one), leukemia (one), adenocarcinoma of the lung (one), prostate carcinoma (one), and malignant melanoma (one). Three of seven patients had metastatic disease evident only within the CNS, while four patients had widespread disease outside the CNS. We conclude that contrast-enhanced MR imaging is useful in the diagnosis of pial spread of metastatic disease in patients with a known primary malignancy and unexplained neurologic signs or symptoms.

Adult↗

PubMed2006

Robust measures of three-dimensional vascular tortuosity based on the minimum curvature of approximating polynomial spline fits to the vessel mid-line.

The clinical recognition of abnormal vascular tortuosity is important in the diagnosis of many diseases. This paper presents a novel approach to the quantification of vascular tortuosity, using robust metrics based on unit speed parameterizations of three-dimensional (3D) curvature. The use of approximating polynomial spline-fitting obviates the need for arbitrary filtering of mid-line data which is necessary with other tortuosity indices. The metrics were tested using both two-dimensional and three-dimensional synthesized images that mimicked clinically significant pathologies: two of the three metrics were scale invariant, additive, and produced tortuosity values tailored to be independent of the resolution of the imaging system. Our methodology is designed to explicitly handle the challenge of noisy data, and is largely tolerant of the inaccuracies in the mid-line extraction. While all the proposed metrics are sensitive to gently curved vessels, the rms curvature of the smoothest path was more effective in recognizing abnormalities involving high-frequency coiling such as occurs in malignant tumors. We have also indicated how values from two projection images, such as acquired in biplane angiography, can be combined to give an accurate approximation of the 3D value of this metric. Our proposed methodology is well-suited to automated detection and measurement, which are a prerequisite for clinical implementation.

Algorithms↗

PubMed2000

Retro-dental reactive lesions related to development of myelopathy in patients with atlantoaxial instability secondary to Os odontoideum.

STUDY DESIGN: A retrospective analysis of 13 patients with atlantoaxial instability secondary to Os odontoideum who underwent posterior atlantoaxial fusion. OBJECTIVE: To assess the relationships between the development of myelopathy and plain radiographic parameters in patients with atlantoaxial instability secondary to Os odontoideum and to determine whether the pathologic structures, which compress the spinal cord, are visualized using magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: The development of myelopathy, which is the most serious complication associated with Os odontoideum, was thought to be related to either the degree of instability or direction of instability, or a decrease in the space available for the cord. However, such indirect radiographic parameters measured using plain radiographs cannot provide direct information concerning the causes of myelopathy in patients with atlantoaxial instability secondary to Os odontoideum. METHODS: Thirteen patients who underwent posterior atlantoaxial fusion for clinical symptoms due to Os odontoideum were classified into two groups depending on whether they had (n = 9) or did not have (n = 4) myelopathy. Four radiographic parameters were measured using flexion and extension lateral radiographs; the degree of instability, the direction of instability, and the space available for the cord in flexion and extension. MRI was performed on all patients in the myelopathy group. The radiologic and clinical data were compared for the two groups. RESULTS: There were no significant statistical differences in the degree of instability (6.83 vs. 7.38, P = 0.816), space available for the cord in flexion (6.94 vs. 7.13, P = 0.938), and space available for cord in extension (7.56 vs. 5.75, P = 0.434) between the two groups. There was a poor agreement between the direction of instability and the development of myelopathy (kappa = 0.268, P = 0.308). Magnetic resonance imaging did demonstrate, however, cord compression caused by retro-dental reactive lesions in the myelopathy; cystic masses were present in two patients; and fibrocartilaginous masses were present in seven. CONCLUSION: The current study suggests that the value of plain radiographic parameters should be reevaluated as a means of evaluating myelopathy in patients with atlantoaxial instability secondary to Os odontoideum, and that retro-dental reactive lesions should be considered as the potential cause of myelopathy.

Adult↗

PubMed2004

Comparison of sequential versus simultaneous methods of adrenal venous sampling.

PURPOSE: To compare two methods of adrenal venous sampling (AVS) in preoperative localization of adrenal lesions in primary hyperaldosteronism. MATERIALS AND METHODS: Twenty-one patients (13 men, eight women) underwent selective adrenal venous sampling between July 2001 and May 2003. One of the 21 patients underwent repeat AVS, for a total of 22 procedures. In half the procedures (n = 11), simultaneous bilateral adrenal venous catheterization and sampling was performed before and after intraprocedural adrenocorticotropic hormone (ACTH) administration; in the remaining half (n = 11), sequential catheterization of the left and right adrenal veins was performed during continuous ACTH infusion 1 hour before and throughout AVS. Chart review provided procedural data, including sampling intervals and aldosterone/cortisol ratios. Patient records provided clinical data, including blood pressure, serum aldosterone levels, and computed tomography and magnetic resonance imaging findings. Surgical pathology reports confirmed unilateral disease but were not applicable to bilateral disease. RESULTS: Selective AVS was completed successfully in 21 of 22 procedures (95%); the unsuccessful sampling was repeated successfully. Disease lateralized in 13 of 22 cases. Simultaneous bilateral AVS localized unilateral disease in seven of eight cases (88%) and was nondiagnostic in one case (13%), with cases confirmed by surgical pathology reports. Sequential bilateral AVS localized unilateral disease in four of four cases (100%) confirmed by surgical pathology reports, with one lost to follow-up. Bilateral disease was diagnosed in six of 22 cases: two of 11 by simultaneous AVS and four of 11 by sequential AVS. Three of 22 cases demonstrated borderline hormone levels that failed to meet the diagnostic threshold for recommended adrenalectomy. Mean elapsed time between acquisition of right and left samples did not differ between simultaneous and sequential AVS (P = .09). Baseline (prestimulation) sampling did not contribute unique diagnostic information in any case and provided contradictory or confounding information in three of 11 simultaneous AVS procedures (27%). CONCLUSIONS: Sequential bilateral catheterization does not compromise the reliability of time-sensitive AVS. Both simultaneous and sequential AVS are adequate studies; however, obtaining baseline prestimulation samples during simultaneous AVS is unnecessary and increases the cost of the procedure.

Adrenal Glands↗

PubMed1990

Cysts of the prostate and seminal vesicles: MR imaging findings in 11 cases.

Cysts of the prostate and seminal vesicles are confusing abnormalities because they are uncommon and their origin is uncertain. Several approaches to diagnosis have been used, most recently CT and transrectal sonography. In this study, we investigated the value of MR imaging in the diagnosis of six cases of prostatic cyst and five cases of cysts of the seminal vesicles. All patients were symptomatic. T1- and T2-weighted spin-echo images were obtained in all cases; pathologic confirmation was available in four patients. MR images were analyzed prospectively without knowledge of clinical data or the results of other imaging procedures. In all cases, low- and high-signal masses were observed on T1- and T2-weighted images, respectively. The cysts were unilocular with a sharply defined margin, ranging from 0.5 to 3.0 cm in diameter. The thin wall was of low signal intensity on T2-weighted images. Our experience suggests that MR imaging is useful in demonstrating the liquid content of prostatic and seminal-vesicle cysts and in establishing their size and location.

Adult↗

PubMed1989

[A case of a non-reading child. Application of the aphasiologic methods. Results].

Children over nine who can't manage to learn written language insofar as they have no major handicap (be it intellectual, sensorial, psycho-affective or socio-cultural) and in spite of psychotherapy and educational and orthophonic measures that have been tried successfully, can be placed in the category of non-readers. Applying aphasiological reeducation methods to one child of eleven who was a non-reader with a well-documented therapeutic past allowed him to learn to read and write in six months. This approach is based on an enlarged definition of aphasia and theoretical hypotheses derived from the theories of the linguist Gustave Guillaume. A pragmatic approach emerges, analyzing and placing the observed weakness in an outline of linguistic functions: a set of the circuits connecting mental images (oral and graphic) to words and sensorial data. Each time a weak point or a pathological mechanism can be pinned down and analyzed, it can lead to an adapted strategy of reeducation which, because its success can be checked, allows us to keep the original hypothesis. In this case, setting up a lexical procedure that could be closely checked and within a reasonable time frame, whereas all the other methods had been inefficient, shows how reliable this way is, and therefore its theoretical interest.

Aphasia↗

PubMedDate not supplied

Post-mortem aeroportography.

The authors suggest a new methodology for the study of the intrahepatic portal system, using atmospheric air as a contrast medium. They used 48 livers of normal and pathological corpses, obtaining post-mortem cholangiographies and vinyl molds. Comparing the images obtained with literature data and with the vinyl molds, the authors conclude that the method is accurate, presenting furthermore many advantages with regard to contrasts generally used, such as low cost, easy performance, possibility repeating the radiographs as many times as necessary, and the possibility of simultaneous obtaining contrasts of other intra-hepatic systems by use of other radio-opaque contrast media in another system, as for example the biliary or the arterial system.

Air↗

PubMed2005

Electro-clinical and imaging characteristics of focal cortical dysplasia: correlation with pathological subtypes.

INTRODUCTION: Focal cortical dysplasia (CD) is a common cause of pharmaco-resistant epilepsy. CD is due to abnormalities in neuronal migration, proliferation, and/or differentiation that result in four distinct pathological subtypes: 1A, 1B, 2A, and 2B. In order to provide clinical correlation to these pathological subtypes, we reviewed the electro-clinical and imaging characteristics and surgical outcomes of the four pathological subtypes of CD. METHODS: We retrospectively reviewed patient data from epilepsy surgeries at the Cleveland Clinic Foundation between 1990 and 2002. Only those patients with the definite pathological diagnosis of isolated cortical dysplasia were included in the study (n = 145). RESULTS: Pathological subtypes 2A and 2B were predominantly frontal in location, and had a more severe epilepsy syndrome with lower intelligence quotient scores than subtypes 1A and 1B. Patients with subtype 1A FCD had less severe, later onset epilepsy that was predominantly located in the temporal lobe. Risk factors for epilepsy included febrile seizures for type 1A, head trauma for types 1A and 1B, and perinatal adverse events for type 2B. Type 2B demonstrated significantly more FLAIR signal abnormalities than the other groups. Sixty-three percent of patients overall had an Engel I outcome at 6 months follow-up. The best outcomes were in the 2B subtype, and in those who did not require an invasive EEG evaluation. CONCLUSIONS: Clinically important differences exist between the pathological subtypes of CD, which may assist in their management, and provide further insight into their underlying pathophysiology.

Adolescent↗

PubMedDate not supplied

Radiologic techniques used to evaluate the temporomandibular joint; I. Conventional methods.

Symptoms of temporomandibular joint pathology are present in a relatively high proportion of the population. Conventional radiographic techniques used to evaluate the morphology of the joint provide data which may be difficult to interpret. These techniques are reviewed briefly and their interpretational shortcomings are noted. Computed tomography is currently being used by some clinicians to evaluate the joint. This technique may also yield data which are difficult to interpret. Extended processing of CT data to provide three-dimensional images of the joint enhances the technique as a means of diagnosing hard tissue pathology, but despite reports in the literature detailing its use in diagnosing soft tissue pathology, CT is not optimal for this purpose. The introduction of nuclear magnetic resonance imaging provides a means of examining the soft tissues of the joint in either two- or three-dimensional images and has the advantage over all previous techniques in that the patient is not subjected to ionizing radiation during the scan process.

Humans↗

PubMed2001

Virtual endoscopy of the labyrinth, using a 3D-FastASE sequence.

Virtual endoscopy (VE) of the labyrinth was performed using three-dimensional (3D)-fast asymmetric spin-echo MR imaging. The spatial resolution requirements and the usefulness of zero-fill interpolation (ZIP) were evaluated, and VE was used to examine three patients. The (0.6-mm) voxel data with ZIP satisfies the minimum requirements for VE for evaluation of the complex 3D anatomy and pathology of the labyrinth. J. Magn. Reson. Imaging 2001;13:792-796.

Adolescent↗

PubMed1996

[Magnetic resonance imaging of laryngeal cancer].

MRI data of twenty-four cases of laryngeal cancer were analysed and compared with the findings of postsurgical pathology. The results revealed that MRI could clearly demonstrate the three dimensional representations of tumor pathology, and correctly depict invasion of paraglottic space (PGS), and preepiglottic space (PES), and precisely display involvement of laryngeal cartilage by cancer. It was considered that MRI was of great importance in determining appropriate therapy for laryngeal cancer.

Adult↗

PubMed2005

Three-dimensional retinal imaging with high-speed ultrahigh-resolution optical coherence tomography.

PURPOSE: To demonstrate high-speed, ultrahigh-resolution, 3-dimensional optical coherence tomography (3D OCT) and new protocols for retinal imaging. METHODS: Ultrahigh-resolution OCT using broadband light sources achieves axial image resolutions of approximately 2 microm compared with standard 10-microm-resolution OCT current commercial instruments. High-speed OCT using spectral/Fourier domain detection enables dramatic increases in imaging speeds. Three-dimensional OCT retinal imaging is performed in normal human subjects using high-speed ultrahigh-resolution OCT. Three-dimensional OCT data of the macula and optic disc are acquired using a dense raster scan pattern. New processing and display methods for generating virtual OCT fundus images; cross-sectional OCT images with arbitrary orientations; quantitative maps of retinal, nerve fiber layer, and other intraretinal layer thicknesses; and optic nerve head topographic parameters are demonstrated. RESULTS: Three-dimensional OCT imaging enables new imaging protocols that improve visualization and mapping of retinal microstructure. An OCT fundus image can be generated directly from the 3D OCT data, which enables precise and repeatable registration of cross-sectional OCT images and thickness maps with fundus features. Optical coherence tomography images with arbitrary orientations, such as circumpapillary scans, can be generated from 3D OCT data. Mapping of total retinal thickness and thicknesses of the nerve fiber layer, photoreceptor layer, and other intraretinal layers is demonstrated. Measurement of optic nerve head topography and disc parameters is also possible. Three-dimensional OCT enables measurements that are similar to those of standard instruments, including the StratusOCT, GDx, HRT, and RTA. CONCLUSION: Three-dimensional OCT imaging can be performed using high-speed ultrahigh-resolution OCT. Three-dimensional OCT provides comprehensive visualization and mapping of retinal microstructures. The high data acquisition speeds enable high-density data sets with large numbers of transverse positions on the retina, which reduces the possibility of missing focal pathologies. In addition to providing image information such as OCT cross-sectional images, OCT fundus images, and 3D rendering, quantitative measurement and mapping of intraretinal layer thickness and topographic features of the optic disc are possible. We hope that 3D OCT imaging may help to elucidate the structural changes associated with retinal disease as well as improve early diagnosis and monitoring of disease progression and response to treatment.

Anatomy, Cross-Sectional↗

PubMed2004

Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease.

HYPOTHESIS: The diagnostic yield of chest radiography; computed tomography (CT) of the chest, abdomen, and pelvis; and CT or magnetic resonance imaging of the brain in the initial evaluation of melanoma with metastasis to sentinel lymph nodes may not identify systemic disease. DESIGN: Retrospective analysis. SETTING: Tertiary care referral center. PATIENTS: Of 1183 patients identified from a database of individuals who underwent selective sentinel lymphadenectomy for primary melanoma (Breslow thickness, 0.2-30 mm), we studied 185 with at least 1 sentinel lymph node positive for metastatic melanoma (Breslow thickness, 0.8-14.5 mm). INTERVENTIONS: Chest radiography; CT of the chest, abdomen, and pelvis; and CT or magnetic resonance imaging of the brain after selective sentinel lymphadenectomy with positive sentinel lymph nodes. The medical records of the 185 patients were systematically reviewed by 4 physician reviewers, and data were extracted primarily from pathology and radiology reports. When medical records were unavailable, information was taken from formal clinic and inpatient progress notes. MAIN OUTCOME MEASURE: Diagnostic yield of imaging studies. RESULTS: The results of 0.5% of the imaging studies were positive for metastatic disease, 86% were negative, and 14% were indeterminate. Indeterminate results were confirmed to be negative by additional studies ranging from repeated imaging to invasive procedures, including thoracotomy and brain biopsy. The yields are as follows: chest radiography, 0%; chest CT, 0.7%; abdominal and pelvic CT, 0.7%; brain CT, 0%; and brain magnetic resonance imaging, 0%. Only 1 patient (0.5%) had detectable metastatic disease, and he had symptoms of systemic disease at the time of imaging. CONCLUSIONS: Computed tomography of the chest, abdomen and pelvis, and brain rarely reveals systemic metastasis at the time of selective sentinel lymphadenectomy. Routine imaging of asymptomatic patients at the time of selective sentinel lymphadenectomy is not indicated.

Brain Neoplasms↗

PubMedDate not supplied

Numerical grading of astrocytomas.

Ninety-three astrocytomas from biopsy material including glioblastomas ('astrocytomas grade 4') were graded according to Kernohan (1949) by light microscopy. Feulgen sections were subjected to an automated microscopic analysis to obtain morphometric-densitometric data of the tumour cell nuclei. These quantitative and reproducible data showed a significant correlation with malignancy expressed in terms of Kernohan and prove automated image analysis to be a valuable tool in the grading of gliomas. This is in particular true if the nuclear parameters determined by image analysis are completed by histologic features which were recorded semiquantitatively by subjective light microscopic evaluation as is usual in clinic pathologic diagnosis of brain tumours. A quadratic discriminant analysis of morphometric-densitometric data of tumour cell nuclei and semiquantitative microscopic data gave a 94% agreement with subjective grading.

Astrocytoma↗

PubMed2006

[Value of MRI in the assessment of invasion depth by endometrial carcinoma].

OBJECTIVE: To evaluate the value of MR imaging in the assessment of invasion depth by endometrial carcinoma. METHODS: Data of 122 patients with endometrial carcinoma proved by postoperative pathology were retrospectively reviewed. Preoperatively, all patients underwent conventional and contrast-enhanced MR scan. Compared with the results of pathology, the sensitivity, specificity and accuracy of different invasion depth determined by MRI were analyzed with SPSS software based on whether the junctional zone was involved or not as the criterion of myometrial invasion. RESULTS: (1) Based on MRI image, the tumor was confined to the endometrium in 17 patients, causing superficial myometrial invasion 60, deep-myometrial invasion 40 and having penetrated the serosa 5. Compared with postoperative pathology results, the incidence of sensitivity, specficity and accuracy of MRI assessment for tumor confined to endometrium was 64.7%, 94.3%, 90.2%, respectively; to superficial myometrial invasion: 64.6%, 82.5%, 70.5%, respectively; to deep-myometrial invasion: 94.4%, 77.9%, 80.3%, respectively; to tumor having penetrated the serosa: 80.0%, 99.1%, 98.4%, respectively. (2) Based on intact junctional zone as the criterion of tumor confined to endometrium, the sensitivity, specficity, accuracy, positive and negative predictive value was 92.9%, 67.9%, 73.1%, 43.3%, 97.3%, respectively. Based on the interruption of junctional zone as the criterion of tumor having involved the myometrium, the sensitivity, specficity, accuracy, positive and negative predictive value was 67.9%, 92.9%, 73.1%, 97.3%, 43.3%, respectively. CONCLUSION: MRI is valuable in the assessment of the invasion depth by endometrial carcinoma, and the dose plays an important role for the clinician in selecting proper way of therapy.

Adult↗

PubMed1992

DNA quantitation of Wilms' tumour (nephroblastoma) using flow cytometry and image analysis.

AIMS: To compare flow cytometry (FCM) with image analysis (IA) in the DNA quantitation of Wilms' tumour (WT) and to correlate data so obtained with recognised clinical and pathological prognostic parameters. METHODS: Thirty six patients with histologically proved WT diagnosed between 1980-89 were investigated. Fifteen patients had stage I disease, 10 stage II, six stage III, two stage IV and three stage V. Suspension of nuclei obtained by pepsin digestion of paraffin wax embedded tumour tissue was analysed using a FAC-Scan flow cytometer, and a CAS-100 image analyser. RESULTS: Tumours were concordant in most instances, however, IA identified aneuploidy in two tumour samples which were diploid by FCM. Aneuploidy was detected in 5/33 tumours with favourable histology and 3/3 with unfavourable histology. Three of 28 patients with Stage I, II and V disease and 5/8 patients with stage III and IV had aneuploid tumours. All patients with unfavourable histology died of disease. In the group with favourable histology, 4/5 patients with aneuploid tumours developed recurrent disease compared with 1/27 diploid tumours (p less than 0.0001). CONCLUSIONS: Ploidy may be a useful additional prognostic indicator in Wilms' tumour with favourable histology. Larger scale studies are needed to confirm the relation of ploidy to survival in early stage WT.

Child↗

PubMed1985

[Pseudotumoral and subacute pathology of the epididymis. Contribution of ultrasonics].

Three patients presented with atypical subacute epididymal disorders diagnosed clinically as a scrotal tumor. Ultrasound imaging provided satisfactory morphologic data on lesions. Cold surgery was performed, either because of major functional disturbance (multiple epididymal abscesses) or because of doubt with respect to diagnosis (spermatic granuloma and epididymal hematoma). Castration was the final procedure in each case. Even though this surgical attitude appears logical because of the serious nature of the lesions, the revised clinical diagnosis provided by ultrasonography and the very good correlation between pathologic and ultrasonic findings should lead to a more eclectic therapeutic attitude in other cases.

Acute Disease↗

PubMedDate not supplied

Accuracy of computed tomography and magnetic resonance imaging in staging bronchogenic carcinoma.

Sixty-three patients with non-small cell bronchogenic carcinoma were prospectively and independently assessed by computed tomography (CT) and magnetic resonance imaging (MRI) before surgery. Images were interpreted by four radiologists who had no knowledge of other imaging studies, except chest x-ray, and were blinded to surgical findings. The data were compared with pathologic and histologic findings. The accuracies of CT and MRI in determining tumor classification and assessing mediastinal and hilar lymph node metastases were compared. Sensitivity of CT in determining T factor was 78%, and specificity was 96%. The values for MRI were 84% and 96%, respectively. There was no significant difference between CT and MRI in staging tumors. MRI is more accurate than CT in diagnosing mediastinal invasion in staging superior sulcus tumors and complex tumors. There was no significant difference between the accuracies of CT and MRI in detecting mediastinal node metastases; the sensitivities were 82% and 90%, respectively, and specificities were 88% and 93%, respectively.

Carcinoma, Bronchogenic↗